1. Intravenous thrombolysis for ischemic stroke in the Veneto region: the gap between eligibility and reality
- Author
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Antonella De Boni, Alessandro Campagnaro, Carmine Tamborino, Agnese Tonon, Federica Orlando, Alessandro Adami, Simona Carella, Franco Ferracci, Giorgio Caneve, Maela Masato, Francesco Perini, Floriana De Biasia, Francesco Paladin, M. Turazzini, Martina Bruno, Piero Nicolao, Michele Morra, Bruno Bonetti, Giampietro Zanette, Roberto L’Erario, Claudio Baracchini, Anna Maria Basile, Manuel Cappellari, Sandro Zambito Marsala, Simone Tonello, M Atzori, Alessandra Danese, Silvia Favaretto, Adriana Critelli, Stefano Forlivesi, Emanuele Turinese, Giulio Bozzato, Salvatrice Bazzano, Roberta Padoan, Alessandro P. Burlina, Silvia Vittoria Guidoni, Paolo Bovi, Federica Viaro, Anna Gaudenzi, Silvia Ricci, Morena Cadaldini, D Idone, Sandro Bruno, Elisabetta Menegazzo, and Monia Russo
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Health Personnel ,030204 cardiovascular system & hematology ,Brain Ischemia ,Stroke onset ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Thrombolytic Therapy ,030212 general & internal medicine ,Acute ischemic stroke ,Acute stroke ,Aged ,Health professionals ,business.industry ,Ischemic strokes ,Stroke units ,Hematology ,Thrombolysis ,Middle Aged ,Stroke ,Italy ,Ischemic stroke ,Emergency medicine ,Practice Guidelines as Topic ,Administration, Intravenous ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Intravenous thrombolysis (IVT) is the treatment of choice for most patients with acute ischemic stroke. According to the recently updated guidelines, IVT should be administered in absence of absolute exclusion criteria. We aimed to assess the proportion of ischemic strokes potentially eligible and actually treated with IVT, and to explore the reasons for not administering IVT. We prospectively collected and analyzed data from 1184 consecutive ischemic stroke patients admitted to the 22 Stroke Units (SUs) of the Veneto region from September 18th to December 10th 2017. Patients were treated with IVT according to the current Italian guidelines. For untreated patients, the reasons for not administering IVT were reported by each center in a predefined model including absolute and/or relative exclusion criteria and other possible reasons. Out of 841 (71%) patients who presented within 4.5 h of stroke onset, 704 (59%) had no other absolute exclusion criteria and were therefore potentially eligible for IVT according to the current guidelines. However, only 323 (27%) patients were eventually treated with IVT. Among 861 (73%) untreated patients, 480 had at least one absolute exclusion criterion, 283 only relative exclusion criteria, 56 only other reasons, and 42 a combination of relative exclusion criteria and other reasons. Our study showed that only 46% (323/704) of the potentially eligible patients were actually treated with IVT in the SUs of the Veneto region. All healthcare professionals involved in the acute stroke pathway should make an effort to bridge this gap between eligibility and reality.
- Published
- 2018